A Single randomized controlled trial in a psychogeriatric institution in the Netherlands showed that UV irradiation of 1,000 cm2 skin of the back of elderly LY2874455 subjects three times per week with half

the minimal erythematous dose was as effective as a daily oral dose of 400 IU vitamin D3 to raise serum levels of 25-hydroxyvitamin D and suppress secondary hyperparathyroidism [104]. Although, this proof of concept with UV irradiation approach is conceptually interesting, oral supplementation remains a more practical solution to prevent or treat vitamin D insufficiency. Moreover, present recommendations suggest higher dosing of vitamin D supplements and besides feasibility, the skin safety of the required equivalent, more extensive UV irradiation might become an issue. Along the same line, although more time

spent outdoor and moderate sun exposure should be encouraged in elderly subjects in reasonably good general health, advising a marked increase of exposure to sunlight might be a somewhat confusing message, at odds with advices concerning the prevention of skin cancer. Anyhow, it is unlikely that to encourage increased exposure to sunlight could alleviate the need for oral vitamin D supplementation. As to physical inactivity, selleck products the use of hypnotic and sedative drugs, and inappropriate housing conditions, four important risk factors for fracture related to lifestyle, these Nintedanib (BIBF 1120) are discussed in the sections on exercise and prevention of falls. Although there undoubtedly exist interactions

between different lifestyle-related influences on bone health and fracture risk, available information on such interactions is rather limited. Nevertheless, it has been shown for several of these that they contribute at least to some extent independently to fracture risk, also independently from the effect of low BMD and high age: i.e. low BMI, excess alcohol consumption, and actual smoking [79]. Fall prevention Between 28% and 35% of adults aged 65 years and older and living in the community experience at least one fall each year, and the annual fall prevalence increases with ageing [105, 106]. Between 10% and 31% are recurrent fallers [107, 108]. More importantly, community-dwelling persons with find more dementia have the highest risk for falls with prevalence rates up to 66%, with clear differences depending on the subtype of dementia (e.g. prevalence of falls in Alzheimer’s disease 47%, vascular dementia 47%, Lewy body dementia 77%, and Parkinson’s disease dementia 90%, respectively) [109]. For those living in nursing care facilities, the annual risk of falls has been estimated to be also three times higher (i.e. up to 70%), and 15% to 40% are recurrent with rates between 1.1 and 1.